Individual
MR. KENNETH WAYNE FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
5881 W 16TH ST STE A, GREELEY, CO 80634-2910
(970) 652-2454
(970) 652-2447
Mailing address
2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
(970) 624-4439
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA16558
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16558
PHYSICIAN ASSISTANT BOARD
CA
Enumeration date
08/31/2006
Last updated
11/20/2023
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